| NPI | 1780021519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2016-01130) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 255460) |
| 207P00000X Emergency Medicine (Licence: TN 0000056066) | |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2023-10-25 |