| NPI | 1811906522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IN 02003945) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 1993) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2011-12-20 |