| NPI | 1013150606 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: DC MD041925)  | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD D0076921)  | 
| Enumeration Date | 2009-04-12 | 
| Last Update Date | 2021-06-25 |