| NPI | 1619031267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME128366) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 010240374) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2016-06-23 |