| NPI | 1508197591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 57508) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NE 28650) |
| Enumeration Date | 2010-01-15 |
| Last Update Date | 2023-06-08 |