| NPI | 1962792432 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NE 1238)  | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 5274)  | 
| Enumeration Date | 2011-04-18 | 
| Last Update Date | 2019-02-06 |