| NPI | 1922348655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VT 032-0134112) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0102203901) |
| Enumeration Date | 2013-02-16 |
| Last Update Date | 2023-07-27 |