| NPI | 1881665966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 29503) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101238619) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2020-02-26 |