| NPI | 1619956539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 46766) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME 88895) |
| 207P00000X Emergency Medicine (Licence: PA MD 417125) | |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2011-01-31 |