| NPI | 1528325198 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL 19231) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NE 1055) | 
| Enumeration Date | 2012-04-19 | 
| Last Update Date | 2022-10-05 |