| NPI | 1831396100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME35504) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 147633-1) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2007-07-09 |