| NPI | 1275602575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN MD0000019445) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA O6886R) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2019-01-03 |