| NPI | 1790806826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2012-01105) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 1623) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2020-08-13 |