| NPI | 1013357102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101020513) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV DO2201) |
| 207P00000X Emergency Medicine (Licence: CA 20A17032) | |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2020-11-15 |