| NPI | 1053769893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD61171597) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 295105) |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2021-12-28 |