| NPI | 1497129969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5151016066) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601007486) |
| Enumeration Date | 2015-11-21 |
| Last Update Date | 2023-05-09 |