| NPI | 1801818042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 64912) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME73399) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2015-12-14 |