| NPI | 1063851707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA MD.304881) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2013018116) |
| Enumeration Date | 2013-06-16 |
| Last Update Date | 2022-07-21 |