| NPI | 1972690584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: LA 15241R) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 40871) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2008-12-30 |