| NPI | 1083092621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA OP60841908) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101021680) |
| Enumeration Date | 2015-05-15 |
| Last Update Date | 2018-09-18 |