| NPI | 1104025063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101230342) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 059518) |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2022-05-03 |