| NPI | 1144640681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME145168) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 270019) |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2020-05-05 |