| NPI | 1760512966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 134234) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: HI 15211) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2009-07-21 |