| NPI | 1609077619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA MD206052) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL TRN11194) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2014-01-09 |