| NPI | 1831176130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 116519) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 0422373) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2021-04-09 |