| NPI | 1619931532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MD d0058527) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD42923) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2009-08-25 |