| NPI | 1811164114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102203097) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT012339) |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2012-11-05 |