| NPI | 1851379119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WY 6690A) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ID M8716) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2008-05-06 |