| NPI | 1043636202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GU M-2191) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0116027243) |
| Enumeration Date | 2014-03-12 |
| Last Update Date | 2019-12-17 |