| NPI | 1851824528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV 19752) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ R76036) |
| Enumeration Date | 2017-04-09 |
| Last Update Date | 2020-06-27 |