| NPI | 1831162031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 97-00228) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 19025) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2021-06-03 |