| NPI | 1669632287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101277412) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 263046-1) |
| 207P00000X Emergency Medicine (Licence: GA 76201) | |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2023-01-12 |