| NPI | 1790866242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 200400825) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME97443) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2009-10-20 |