| NPI | 1710410527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA OP61049885) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101025525) |
| 207P00000X Emergency Medicine (Licence: WI 73005-21) | |
| 207P00000X Emergency Medicine (Licence: UT 11725396-1204) | |
| Enumeration Date | 2017-04-07 |
| Last Update Date | 2020-07-28 |