| NPI | 1679093363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2021014913) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2017016919) |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2021-05-18 |