| NPI | 1518352756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2020-01003) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: DC MD045950) |
| Enumeration Date | 2015-04-04 |
| Last Update Date | 2021-10-03 |