| NPI | 1336438282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 71540) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 25415) |
| 207P00000X Emergency Medicine (Licence: VA T63-66-6209) | |
| Enumeration Date | 2011-03-31 |
| Last Update Date | 2019-07-30 |