| NPI | 1295155596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101020957) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 68361-21) |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2024-02-12 |