| NPI | 1780966515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV DO2305) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL OS11193) |
| 207P00000X Emergency Medicine (Licence: VA 0102207033) | |
| 207P00000X Emergency Medicine (Licence: OK DO2305) | |
| 207P00000X Emergency Medicine (Licence: GA 069461) | |
| 207P00000X Emergency Medicine (Licence: AL DO.1547) | |
| Enumeration Date | 2011-09-19 |
| Last Update Date | 2022-12-08 |