| NPI | 1619084639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN MD39742) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101242546) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2020-08-07 |