| NPI | 1114970373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301072041) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 4301072041) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2022-12-27 |