| NPI | 1245595123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5315055663) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301100993) |
| Enumeration Date | 2012-07-07 |
| Last Update Date | 2018-05-31 |