| NPI | 1760614689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 48425) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 68487) |
| 207P00000X Emergency Medicine (Licence: FL ME136544) | |
| Enumeration Date | 2009-08-11 |
| Last Update Date | 2023-04-05 |