| NPI | 1669608857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME119145) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301094462) |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2015-06-08 |