| NPI | 1730562554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KS 0545912) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 86906) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2022-04-12 |