| NPI | 1568578482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 36203) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM 2006-0299) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2020-10-14 |