| NPI | 1194163444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301102628) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM MD2017-0423) |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2019-01-11 |