| NPI | 1629055488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 64217-21) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 234542) |
| 207P00000X Emergency Medicine (Licence: IA 3801) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2019-05-10 |