| NPI | 1861730541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL OS12518) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 6572) |
| Enumeration Date | 2013-01-30 |
| Last Update Date | 2015-02-15 |