| NPI | 1659665800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 72061) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC LL 33539) |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2014-07-22 |