| NPI | 1780683847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV WV19052) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101262068) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2023-03-07 |