| NPI | 1699191635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA FS4822195) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GU M-2150) |
| Enumeration Date | 2014-03-14 |
| Last Update Date | 2020-07-23 |