| NPI | 1306428958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IA DO-06729) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101027429) |
| Enumeration Date | 2021-04-23 |
| Last Update Date | 2024-07-18 |