| NPI | 1558709105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 65300-20) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA R-9771) |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2022-06-06 |