| NPI | 1588034227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MS 25252) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 58.007148) |
| 207P00000X Emergency Medicine (Licence: WI 75272) | |
| Enumeration Date | 2015-10-06 |
| Last Update Date | 2021-06-08 |