| NPI | 1336407683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 288013) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301108117) |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2017-05-10 |