| NPI | 1598041626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102203742) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 205842) |
| 207P00000X Emergency Medicine (Licence: WV 3038) | |
| 207P00000X Emergency Medicine (Licence: TN 2789) | |
| Enumeration Date | 2011-11-03 |
| Last Update Date | 2016-02-15 |