| NPI | 1629018387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101243177) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 20682) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2021-11-17 |