| NPI | 1902861966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AL 00022749) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME95813) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2008-05-05 |