| NPI | 1790732634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101255480) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 28890) |
| 207P00000X Emergency Medicine (Licence: NM 97-346) | |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2021-03-07 |