| NPI | 1912033499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL 98435) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 57093) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2007-07-08 |