| NPI | 1669600078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 46104) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301094294) |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2021-03-02 |