| NPI | 1780807438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NE 25070) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 941108) |
| 207P00000X Emergency Medicine (Licence: IA 38264) | |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2011-11-06 |