| NPI | 1215421904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102206570) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101023999) |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2021-06-22 |