| NPI | 1164438602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM MD2019-0084) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2012-01100) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2020-05-06 |