| NPI | 1063850063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2019022895) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101020675) |
| 207P00000X Emergency Medicine (Licence: NC 201701207) | |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2019-06-24 |