| NPI | 1710391891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 10158722-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301105484) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2018-03-17 |