| NPI | 1861433112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AK 5758) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A62677) |
| 207P00000X Emergency Medicine (Licence: HI MD12007) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2007-07-08 |