| NPI | 1629564588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5151009712) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101024043) |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2020-04-29 |