| NPI | 1700801669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2006-01543) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD425860) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2007-10-05 |