| NPI | 1740307602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2007038171) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2004025521) |
| Enumeration Date | 2007-03-24 |
| Last Update Date | 2019-12-16 |