| NPI | 1154473304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101246952) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 23560) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2022-07-26 |