| NPI | 1770979510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 59556) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 304723) |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2022-03-29 |