| NPI | 1801391420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AL MD.42207) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 54470) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2021-10-15 |