| NPI | 1578870796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AR E-11559) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301097209) |
| Enumeration Date | 2010-09-09 |
| Last Update Date | 2022-03-24 |