| NPI | 1093135196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101261661) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2016-01283) |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2019-01-08 |