| NPI | 1174147029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME160917) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4351046660) |
| 207P00000X Emergency Medicine (Licence: DE C1-0026483) | |
| 207P00000X Emergency Medicine (Licence: KY 58545) | |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2024-05-15 |