| NPI | 1609086750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301083446) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2007014919) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2020-02-06 |