| NPI | 1518166404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N6276) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301090145) |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2017-01-06 |