| NPI | 1811092752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL 50290) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 161843) |
| 207P00000X Emergency Medicine (Licence: TN MD0000016088) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2011-02-28 |