| NPI | 1619080165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL 084156) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 050123) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2020-10-15 |