| NPI | 1174011647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 1014229) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 315321) |
| 207P00000X Emergency Medicine (Licence: MI 4301510953) | |
| Enumeration Date | 2018-04-30 |
| Last Update Date | 2024-03-21 |