| NPI | 1679836720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q3700) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301100671) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2016-12-23 |