| NPI | 1609829654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 21604) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 200300788) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2021-04-13 |