| NPI | 1730391343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2007-00775) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME104017) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2009-11-09 |