| NPI | 1396435210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101028268) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: MI 5101028268) |
| Enumeration Date | 2023-05-12 |
| Last Update Date | 2026-03-19 |