| NPI | 1275946089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 04281) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101021235) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2023-06-29 |