| NPI | 1679954457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AL 2001) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101022009) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2020-06-13 |