| NPI | 1629108816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME102091) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 127059) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2009-03-17 |