| NPI | 1043650831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 453) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301102940) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2019-08-08 |