| NPI | 1346621513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA 309332) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 209625) |
| Enumeration Date | 2015-06-14 |
| Last Update Date | 2019-01-14 |