| NPI | 1700316841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 05648) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101023409) |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2023-09-25 |