| NPI | 1659996221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 81197) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5151014336) |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2024-01-17 |