| NPI | 1528418688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME143698) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301110575) |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2023-02-03 |