| NPI | 1568608644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N8527) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301092839) |
| Enumeration Date | 2008-12-19 |
| Last Update Date | 2021-09-13 |