| NPI | 1831505544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2018009634) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 3030) |
| 207P00000X Emergency Medicine (Licence: KS 05-40798) | |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2019-03-12 |