| NPI | 1568815223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR DO201596) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL uo5114) |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2023-10-07 |