| NPI | 1346691755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101022785) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 05-42816) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2021-01-07 |