| NPI | 1639157704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101011879) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0102203123) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2012-05-14 |