| NPI | 1649684168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2022014785) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301105209) |
| 207P00000X Emergency Medicine (Licence: SC 40749) | |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2022-09-01 |