| NPI | 1215154018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 50990) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 57.012577) |
| 207P00000X Emergency Medicine (Licence: CO DR.0052737) | |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2021-03-05 |