| NPI | 1790867125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 48462) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 058263) |
| 207P00000X Emergency Medicine (Licence: SC 24037) | |
| 207P00000X Emergency Medicine (Licence: MO 2011035530) | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2021-10-25 |