| NPI | 1578523890 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 36208)  | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0102049892)  | 
| Enumeration Date | 2006-03-23 | 
| Last Update Date | 2020-01-08 |