| NPI | 1639308745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 8624123-1204) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101018476) |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2025-01-16 |