| NPI | 1760407217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 18261) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 0000027918) |
| 207P00000X Emergency Medicine (Licence: NC MD9700457) | |
| 207P00000X Emergency Medicine (Licence: WI 36406) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2012-04-26 |