| NPI | 1376574988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101238837) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2015-02138) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2022-08-18 |