| NPI | 1790718443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101230986) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 28480) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2018-10-25 |