| NPI | 1588893432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101018227) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: MI 5101018227) |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2012-07-25 |