| NPI | 1780685040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 1217) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 200501214) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2016-07-18 |