| NPI | 1942382924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 430139945) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 23701-020) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2007-07-08 |