| NPI | 1538370358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2019009732) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101263869) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2019-07-12 |