| NPI | 1629414701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2016-00882) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 39300) |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2021-01-21 |