| NPI | 1669544755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101059315) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 20116) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2021-10-27 |