| NPI | 1154419562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI 4301062072) |
| Additional Taxonomies | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: MI 4301062072) |
| 207R00000X Internal Medicine (Licence: MI 4301062072) | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2007-07-08 |