| NPI | 1629135439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101241199) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 48157) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2015-02-19 |