| NPI | 1043447113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101248004) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GU MTL-2017-074) |
| 207P00000X Emergency Medicine (Licence: GU M-2072) | |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2019-01-22 |