| NPI | 1609862002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME32665) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 307816) |
| 207P00000X Emergency Medicine (Licence: TX R1012) | |
| 207P00000X Emergency Medicine (Licence: PA MD025727E) | |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2019-11-13 |