| NPI | 1336555366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 288701) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301105475) |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2022-10-06 |