| NPI | 1639512114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 282568) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2017016502) |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2020-12-16 |