| NPI | 1174057400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A169668) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: UT 12172673-1205) |
| 207P00000X Emergency Medicine (Licence: AZ R76071) | |
| 207P00000X Emergency Medicine (Licence: AZ 63254) | |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2021-05-24 |