| NPI | 1902080468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME101102) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 060268) |
| 207P00000X Emergency Medicine (Licence: CA A118275) | |
| 207P00000X Emergency Medicine (Licence: NC 2008-02062) | |
| Enumeration Date | 2007-12-19 |
| Last Update Date | 2012-03-15 |