| NPI | 1508141052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KS 0438429) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PR 28912R) |
| 207P00000X Emergency Medicine (Licence: OH 124158) | |
| 207P00000X Emergency Medicine (Licence: NY 275644) | |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2017-03-02 |