| NPI | 1477133643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4351048254) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2024-01849) |
| Enumeration Date | 2021-04-12 |
| Last Update Date | 2025-12-01 |