| NPI | 1679736029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME116659) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 003227) |
| 207P00000X Emergency Medicine (Licence: MA 247108) | |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2014-03-06 |