| NPI | 1780667501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 21409) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CO 42431) |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2014-02-04 |