| NPI | 1538570098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM MD2018-0661) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301105581) |
| Enumeration Date | 2014-05-17 |
| Last Update Date | 2018-08-08 |