| NPI | 1457532319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102204077) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT010789) |
| Enumeration Date | 2007-11-20 |
| Last Update Date | 2018-11-06 |