| NPI | 1245506229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KS 04-37894) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2014004835) |
| Enumeration Date | 2012-03-23 |
| Last Update Date | 2018-05-16 |