| NPI | 1629455449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OK tbd) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2018032434) |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2018-12-04 |