| NPI | 1891087300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WY 9707A) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 48907) |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2021-02-18 |