| NPI | 1710324504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 60538) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA R - 9742) |
| 207P00000X Emergency Medicine (Licence: IA DO-04797) | |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2018-06-26 |