| NPI | 1770643272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM MD2008-0144) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 218547) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2020-01-07 |