| NPI | 1427582519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR DO213921) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 82148) |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2024-09-16 |