| NPI | 1477552867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2013-00618) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101015120) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2025-03-24 |