| NPI | 1932633021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101276783) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV Pending) |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2023-09-11 |