| NPI | 1619388592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2018008646) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101020996) |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2018-07-31 |