| NPI | 1932101821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC SC879) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 879) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2021-03-30 |