| NPI | 1912352030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 53315) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME140288) |
| Enumeration Date | 2016-04-26 |
| Last Update Date | 2023-06-07 |