| NPI | 1073770582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA MD.202936) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA PGY1 Permit) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2019-07-12 |