| NPI | 1063973865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 77323) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4351044688) |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2022-08-15 |