| NPI | 1649761354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2021027541) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA DO-05795) |
| 207P00000X Emergency Medicine (Licence: IA R-11244) | |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2022-09-02 |