| NPI | 1720072333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV 6126) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A34567) |
| 207P00000X Emergency Medicine (Licence: NM MD2006-0062) | |
| 207P00000X Emergency Medicine (Licence: HI MD13719) | |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2009-11-15 |