| NPI | 1700888633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101241186) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 28831) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2020-07-01 |