| NPI | 1902882871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 47170) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 12074) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2019-01-15 |