| NPI | 1558711911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 83087) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101022301) |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2020-06-05 |