| NPI | 1306377247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 60635) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 226974) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2022-05-10 |