| NPI | 1700236973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA 20A18674) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101024600) |
| 207P00000X Emergency Medicine (Licence: OH 34.014355) | |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2022-01-20 |