| NPI | 1992914105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN DO2047) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD D0065121) |
| 207P00000X Emergency Medicine (Licence: PA OS014183) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2011-11-18 |