| NPI | 1124558119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301113057) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: MI 5315086950) |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2017-06-13 |