| NPI | 1295228633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301115520) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 310122) |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2021-07-02 |