| NPI | 1952450280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 22228) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MT 11674) |
| 207P00000X Emergency Medicine (Licence: WY 7702A) | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2020-08-06 |