| NPI | 1407898737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV DO2280) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101011405) |
| 207P00000X Emergency Medicine (Licence: OH 34009289) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2024-06-06 |