| NPI | 1649321506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101269710) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME103370) |
| 207P00000X Emergency Medicine (Licence: WV 29700) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2021-03-07 |