| NPI | 1811157035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 5657) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA DO 000183) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2011-08-01 |