| NPI | 1871682443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 081313) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 241153) |
| 207P00000X Emergency Medicine (Licence: CA A98078) | |
| 207P00000X Emergency Medicine (Licence: TX M9639) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2018-09-11 |