| NPI | 1023576006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301504884) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4351045659) |
| Enumeration Date | 2019-03-07 |
| Last Update Date | 2022-06-28 |