| NPI | 1710149497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2012-00523) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101017950) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2015-07-28 |