| NPI | 1972575330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 62040) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA a77076) |
| 207P00000X Emergency Medicine (Licence: MA 239025) | |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2020-10-26 |