| NPI | 1740281930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA 09212r) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301066565) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2007-07-08 |