| NPI | 1982928586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: DC MD042173) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD D0077420) |
| 207P00000X Emergency Medicine (Licence: VA 0101256020) | |
| Enumeration Date | 2010-03-25 |
| Last Update Date | 2021-05-27 |