| NPI | 1184834954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 57669-20) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 62978) |
| 207P00000X Emergency Medicine (Licence: MI 4301088813) | |
| 207P00000X Emergency Medicine (Licence: CA a107510) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2024-04-15 |