| NPI | 1205363686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME159192) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2020-02450) |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2023-05-31 |