| NPI | 1912387804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 271718) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 202000357) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2021-03-24 |