| NPI | 1972882454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV ED0246A) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL OS19382) |
| Enumeration Date | 2011-08-15 |
| Last Update Date | 2023-07-24 |