| NPI | 1154817773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME147723) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV 20583) |
| Enumeration Date | 2018-07-06 |
| Last Update Date | 2021-07-05 |