| NPI | 1184845646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL OS14492) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101016466) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2019-06-29 |