| NPI | 1063476992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 29861) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 200000869) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2021-07-02 |