| NPI | 1679581813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AL L.4833SP) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME93462) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2021-01-19 |