| NPI | 1659867562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL OS19094) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT018874) |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2022-08-01 |