| NPI | 1760645543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2013-01399) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 65878) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2014-03-27 |