| NPI | 1760424048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 101041953) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 29124) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2018-08-17 |