| NPI | 1861465627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: MO 2001016005) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2001016005) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2014-12-17 |