| NPI | 1194727016 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101243783) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 23307) |
| 207P00000X Emergency Medicine (Licence: WV 25491) | |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2021-02-28 |