| NPI | 1710915558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA MD.013749) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA 013749) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2012-02-08 |