| NPI | 1942461876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 202K00000X (Licence: LA md.202500) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA MD.202500) |
| 207P00000X Emergency Medicine (Licence: LA PGY.1.EKL-EMR) | |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2021-02-02 |