| NPI | 1710286992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR 171488) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 60094-20) |
| Enumeration Date | 2011-03-27 |
| Last Update Date | 2020-04-17 |