| NPI | 1467074104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 69167) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301508801) |
| Enumeration Date | 2020-05-15 |
| Last Update Date | 2024-04-22 |