| NPI | 1336400639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2014-02448) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD 252576) |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2020-04-10 |