| NPI | 1811252869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R9407) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ R73489) |
| 207P00000X Emergency Medicine (Licence: GU M1981) | |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2018-11-02 |