| NPI | 1871536771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 049919) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2006-00853) |
| 207P00000X Emergency Medicine (Licence: AL 25507) | |
| 207P00000X Emergency Medicine (Licence: KY 40200) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2007-07-08 |