| NPI | 1548619695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME144718) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301117011) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2020-12-22 |