| NPI | 1407381353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ME MD24040) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: UT 10959455-1205) |
| Enumeration Date | 2017-04-28 |
| Last Update Date | 2020-07-10 |