| NPI | 1790799799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 072082) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101015291) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2015-08-11 |