| NPI | 1578590592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO 48811) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 148090) |
| 207P00000X Emergency Medicine (Licence: CA A040683) | |
| 207P00000X Emergency Medicine (Licence: CT 047820) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2011-05-16 |