| NPI | 1356904312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 1015469) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 319357) |
| 207P00000X Emergency Medicine (Licence: MI 4301511223) | |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2024-03-21 |