| NPI | 1215256375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2013021748) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 05-44161) |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2021-01-05 |