| NPI | 1154748382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 50331) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM MD2020-0657) |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2020-07-27 |