| NPI | 1972746998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KS 05-40757) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2013044282) |
| Enumeration Date | 2009-04-07 |
| Last Update Date | 2019-04-05 |