| NPI | 1649200643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101243709) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301074585) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2019-06-10 |