| NPI | 1023422490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2017-01299) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 51195) |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2021-11-15 |