| NPI | 1659396158 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV 5226) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WY 2455A) |
| 207P00000X Emergency Medicine (Licence: IL 036070496) | |
| 207P00000X Emergency Medicine (Licence: CO 27024) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2008-05-06 |