| NPI | 1184060931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 83731) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101260065) |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2022-06-14 |