| NPI | 1164459657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101029301) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 01066085A) |
| 207P00000X Emergency Medicine (Licence: WV 28215) | |
| 207PE0004X Emergency Medicine Emergency Medical Services (Licence: MO 2006028599) | |
| 208000000X Pediatrics (Licence: IN 01066085A) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2023-12-28 |