| NPI | 1609454420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 303112) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC MASL-5ZSWNN) |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2021-04-01 |