| NPI | 1487712360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AK AK3198) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MT Med-Phys-Lic-44357) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2020-10-08 |