| NPI | 1205976107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 18748) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 200100511) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2020-10-13 |