| NPI | 1699902874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME114305) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 67063) |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2013-07-18 |