| NPI | 1700888203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 33438) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV 11260) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2015-07-30 |