| NPI | 1104316959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA 325159) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101025808) |
| Enumeration Date | 2018-05-17 |
| Last Update Date | 2023-08-16 |