| NPI | 1053554089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 46924-20) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35097788) |
| 207P00000X Emergency Medicine (Licence: MI 4301099517) | |
| Enumeration Date | 2009-04-07 |
| Last Update Date | 2014-06-10 |