| NPI | 1902924103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VT 042.0011353) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NH 25020) |
| 207P00000X Emergency Medicine (Licence: DE C7-0003017) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2024-01-17 |