| NPI | 1912940727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2008-00474) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 1140) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2015-04-22 |