| NPI | 1174569107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101012543) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI 012543) |
| 207Q00000X Family Medicine (Licence: FL OS5478) | |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2021-09-23 |