| NPI | 1407040934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 643577) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101275262) |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2022-05-18 |