| NPI | 1245521350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM MD2019-0191) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2014013915) |
| 207P00000X Emergency Medicine (Licence: GU M-2142) | |
| Enumeration Date | 2011-04-22 |
| Last Update Date | 2019-07-26 |