| NPI | 1932391091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MS 21160) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA N/A) |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2012-02-13 |