| NPI | 1417161431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 45005) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2005026648) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2022-07-21 |