| NPI | 1851786925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME135844) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 79770) |
| 207P00000X Emergency Medicine (Licence: KY 51472) | |
| 207P00000X Emergency Medicine (Licence: NM MD2019-0952) | |
| 207P00000X Emergency Medicine (Licence: IA MD-44921) | |
| Enumeration Date | 2015-04-05 |
| Last Update Date | 2020-10-29 |