| NPI | 1023060019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MD D0062650) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101254628) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2021-07-15 |