| NPI | 1962768606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AL 1867) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0102204681) |
| 207P00000X Emergency Medicine (Licence: PA OS016718) | |
| Enumeration Date | 2012-04-06 |
| Last Update Date | 2018-09-27 |