| NPI | 1063551794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102201832) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX N8847) |
| 207P00000X Emergency Medicine (Licence: GA 65421) | |
| 207P00000X Emergency Medicine (Licence: WA op 60108567) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2019-12-10 |