| NPI | 1174962021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME151065) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301102698) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2021-09-27 |