| NPI | 1205209228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 63702) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 0093R) |
| Enumeration Date | 2015-11-13 |
| Last Update Date | 2019-07-30 |