| NPI | 1053308981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 1647) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 200300578) |
| 207P00000X Emergency Medicine (Licence: VA 0102201174) | |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2020-11-04 |