| NPI | 1619992153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: HI 7139) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 038494) |
| 207P00000X Emergency Medicine (Licence: FL 63495) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2013-10-02 |