| NPI | 1780812511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 1281) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 3104) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2019-08-09 |