| NPI | 1073900536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60921402) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV 19264) |
| 207P00000X Emergency Medicine (Licence: AZ R74934) | |
| 207P00000X Emergency Medicine (Licence: IL 036147715) | |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2022-07-14 |