| NPI | 1760831887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD191891) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC LL39574) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2020-11-04 |