| NPI | 1902821861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA MD201664) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD070246L) |
| 207P00000X Emergency Medicine (Licence: FL ME81323) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2007-09-06 |