| NPI | 1518344530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102205538) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101021540) |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2019-08-01 |