| NPI | 1134144520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 35916) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 16337) |
| 2085U0001X Radiology Diagnostic Ultrasound (Licence: NC 35916) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2021-10-15 |