| NPI | 1417304940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NE 2163) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101023337) |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2025-10-14 |