| NPI | 1619164357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101243317) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 37016) |
| Enumeration Date | 2007-09-26 |
| Last Update Date | 2008-09-30 |