| NPI | 1700174950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2014-00565) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA 014197) |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2021-12-15 |