| NPI | 1699068478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2015-00403) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL 978471) |
| 207P00000X Emergency Medicine (Licence: GA 73775) | |
| Enumeration Date | 2011-05-26 |
| Last Update Date | 2016-08-03 |