| NPI | 1831489772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME117097) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PR 12726) |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2016-07-01 |