| NPI | 1154761849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 11723628-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301102906) |
| 207P00000X Emergency Medicine (Licence: NV 21069) | |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2022-01-07 |