| NPI | 1427081983 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ID M-10097)  | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME 83947)  | 
| 207P00000X Emergency Medicine (Licence: IA 34891)  | |
| 207P00000X Emergency Medicine (Licence: OR MD185493)  | |
| Enumeration Date | 2006-07-08 | 
| Last Update Date | 2022-08-04 |