| NPI | 1710320015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101258513) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 60442) |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2019-02-08 |