| NPI | 1053422238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2021007445) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM MD 2009-0058) |
| 207P00000X Emergency Medicine (Licence: MO 110287) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2021-03-03 |