| NPI | 1619028404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME305182) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL MD29580) |
| 207P00000X Emergency Medicine (Licence: GA 062795) | |
| 207P00000X Emergency Medicine (Licence: LA MD203401) | |
| 207P00000X Emergency Medicine (Licence: MS 20885) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2010-01-04 |