| NPI | 1871510321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OK 28048) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA G76359) |
| 207P00000X Emergency Medicine (Licence: LA 10973R) | |
| 207P00000X Emergency Medicine (Licence: WV 18603) | |
| 207P00000X Emergency Medicine (Licence: VA 0101047573) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2019-10-10 |