| NPI | 1679572903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101239381) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 9400010) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2007-07-09 |