| NPI | 1578547790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KS 417246) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO R7021) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2008-03-05 |