| NPI | 1477591147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 28835) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 04-36680) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2021-01-26 |