| NPI | 1255726121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 209650) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 55698) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2021-01-15 |