| NPI | 1578883294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME149502) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI C261071115280) |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2023-02-07 |