| NPI | 1407113905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 26033) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 50739) |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2022-04-08 |