| NPI | 1710265210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MD D0072379) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101258582) |
| Enumeration Date | 2011-08-01 |
| Last Update Date | 2022-04-20 |