| NPI | 1184119141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA 61143185) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301115953) |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2021-07-14 |