| NPI | 1841254299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: HI DOS1104) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 234422) |
| 207P00000X Emergency Medicine (Licence: NJ 25mb08112800) | |
| 207P00000X Emergency Medicine (Licence: OH 34.010600) | |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2014-02-23 |