| NPI | 1639371966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR DO157451) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 20700000X) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2018-05-17 |