| NPI | 1225768781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5151015670) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 22HV-ZVK0-MCZO) |
| Enumeration Date | 2022-06-16 |
| Last Update Date | 2022-06-20 |