| NPI | 1629102363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 33126) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 60615) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2018-07-23 |