| NPI | 1528440229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA 320575) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL 140971) |
| 207P00000X Emergency Medicine (Licence: AL 38253) | |
| 207P00000X Emergency Medicine (Licence: GA 83642) | |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2020-12-19 |