| NPI | 1891715207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2006-01798) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL 66748) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2021-10-18 |