| NPI | 1912169806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 373145-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301092894) |
| 207P00000X Emergency Medicine (Licence: WA MD60207202) | |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2015-08-20 |