| NPI | 1255502316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA MD.202505) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA PGY-2 PERMIT) |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2017-09-25 |