| NPI | 1811370307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 7660) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AK 134734) |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2018-12-07 |