| NPI | 1528417573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301116940) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301109701) |
| 207P00000X Emergency Medicine (Licence: AZ 65751) | |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2022-03-21 |