| NPI | 1780616243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD13593) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ MD54406) |
| 207P00000X Emergency Medicine (Licence: WA MD60807213) | |
| 207P00000X Emergency Medicine (Licence: ME MD21834) | |
| 207P00000X Emergency Medicine (Licence: IA MD44724) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2019-05-15 |