| NPI | 1114128089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101017086) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI 5101017086) |
| 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: MI 5101017086) | |
| 208D00000X General Practice (Licence: MI 5101017086) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2023-06-23 |