| NPI | 1962429415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2000166663) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: MI 4301089119) |
| 207P00000X Emergency Medicine (Licence: PA MD426186) | |
| 207P00000X Emergency Medicine (Licence: LA MD.200542) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2012-08-23 |