| NPI | 1649213554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101241235) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 01061935A) |
| 207P00000X Emergency Medicine (Licence: AZ 36266) | |
| 207P00000X Emergency Medicine (Licence: NY 208568) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2008-07-07 |