| NPI | 1922079367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101241832) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 47715) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2015-02-19 |