| NPI | 1306297643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 008007) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 55614866) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2020-02-10 |