| NPI | 1932401460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO R7121) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 04-17380) |
| 207P00000X Emergency Medicine (Licence: OK 24676) | |
| Enumeration Date | 2010-12-05 |
| Last Update Date | 2010-12-05 |