| NPI | 1568627313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301093714) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.092098) |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2021-09-15 |