| NPI | 1639376593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 12856) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 12856) |
| 207PP0204X Emergency Medicine Pediatric Emergency Medicine (Licence: WV 12856) | |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2021-04-13 |