| NPI | 1588609630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SD 5817) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2004030327) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2007-07-08 |