| NPI | 1063622058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2008011546) |
| Additional Taxonomies | 207P00000X Emergency Medicine |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2022-07-21 |