| NPI | 1134455421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME113385) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2017035456) |
| Enumeration Date | 2009-10-22 |
| Last Update Date | 2018-09-14 |