| NPI | 1285622522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101655831) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD D0045203) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2021-11-09 |