| NPI | 1811962475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A96607) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 46584) |
| 207P00000X Emergency Medicine (Licence: WI 46757) | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2007-07-08 |