| NPI | 1679763791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WY 8452A) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 81892) |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2021-05-24 |