| NPI | 1699185272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR.0062036) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: HI DOS1989) |
| 207P00000X Emergency Medicine (Licence: PA OS017930) | |
| 207P00000X Emergency Medicine (Licence: NC 2018-00485) | |
| 207P00000X Emergency Medicine (Licence: PA OT015717) | |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2019-06-25 |