| NPI | 1972509008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 021112) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD D0068540) |
| 207P00000X Emergency Medicine (Licence: VA 0101057163) | |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2011-04-07 |