| NPI | 1225419211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA 310574) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC LL38466) |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2018-10-22 |