| NPI | 1184641771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101006554) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL OS-3647) |
| 207P00000X Emergency Medicine (Licence: WI 25116-021) | |
| 207P00000X Emergency Medicine (Licence: OH 34 002975) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2019-02-01 |