| NPI | 1053805531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2021016111) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC LL52792) |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2021-07-15 |