| NPI | 1831161314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2006-00362) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD044801L) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2011-11-02 |