| NPI | 1376554477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 20081) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 26964) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2020-12-01 |