| NPI | 1962883280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 73864) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV 17666) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2020-10-01 |