| NPI | 1740589597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 38054) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC LL38054) |
| Enumeration Date | 2011-03-18 |
| Last Update Date | 2021-09-21 |