| NPI | 1134170228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MT 4838) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WY 7154A) |
| 207P00000X Emergency Medicine (Licence: WI 49899) | |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2021-05-12 |