| NPI | 1861889495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 80153) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 308621) |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2018-06-11 |