| NPI | 1578765012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD29036) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301087613) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2024-04-26 |