| NPI | 1518452499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2021043081) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2018020276) |
| Enumeration Date | 2018-06-24 |
| Last Update Date | 2022-06-06 |