| NPI | 1639277452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101008296) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI SJ008296) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2016-01-25 |