| NPI | 1073930475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MD D0084583) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2014-03-24 |
| Last Update Date | 2019-08-16 |