| NPI | 1609161512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL OS12733) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL DO.1412) |
| 207P00000X Emergency Medicine (Licence: LA DO.000380) | |
| 207P00000X Emergency Medicine (Licence: GA 071767) | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2015-09-26 |