| NPI | 1700062288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2008-00579) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MT 90418) |
| Enumeration Date | 2008-01-15 |
| Last Update Date | 2020-10-08 |