| NPI | 1972705325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IA 4180) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101017206) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2011-07-07 |