| NPI | 1871570200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: DE C10006293) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 9500233) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2021-12-03 |