| NPI | 1649567157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60542201) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301098410) |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2020-01-27 |