| NPI | 1871812602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SD 9715) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 58216) |
| Enumeration Date | 2010-05-18 |
| Last Update Date | 2015-12-22 |