| NPI | 1972160547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 96643) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101274553) |
| Enumeration Date | 2019-05-20 |
| Last Update Date | 2023-08-10 |