| NPI | 1225423239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MT MED-PHYS-LIC-125346) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM MD2017-0825) |
| 207P00000X Emergency Medicine (Licence: NM RS2015-0376) | |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2024-01-04 |