| NPI | 1275989048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 82907) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2018-00036) |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2019-07-09 |