| NPI | 1790744647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101299767) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 25633) |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2021-03-03 |