| NPI | 1871957753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL 144841) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101265970) |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2023-01-13 |