| NPI | 1174017958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301115689) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 58430) |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2024-04-11 |