| NPI | 1083655740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD126266) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD D40100) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2018-11-02 |