| NPI | 1811197163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 067357) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MS 719-L) |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2013-09-30 |