| NPI | 1568479673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 37365) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 51083) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2021-05-12 |