| NPI | 1811252331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 37701) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA RTP005475) |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2021-05-07 |