| NPI | 1639420888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 63775) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME117723) |
| Enumeration Date | 2012-09-27 |
| Last Update Date | 2015-07-08 |