| NPI | 1164889176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301406662) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 41947) |
| Enumeration Date | 2016-01-21 |
| Last Update Date | 2016-01-21 |