| NPI | 1124680095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA OP61235301) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5151014042) |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2022-06-26 |