| NPI | 1154731388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 82335) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101021173) |
| Enumeration Date | 2014-04-28 |
| Last Update Date | 2019-07-11 |