| NPI | 1619498920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 41110) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY TP404) |
| 207P00000X Emergency Medicine (Licence: SC LL41110) | |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2023-03-17 |