| NPI | 1306894779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AL FC6201393) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MS 30600) |
| 207P00000X Emergency Medicine (Licence: TN 86292) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2021-12-17 |