| NPI | 1417362104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101021377) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR DO186776) |
| Enumeration Date | 2014-06-22 |
| Last Update Date | 2018-07-23 |