| NPI | 1104818053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2001001462) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 0431384) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2021-02-16 |