| NPI | 1720049109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IA 39945) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 61613) |
| 207P00000X Emergency Medicine (Licence: MI 4301080458) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI 4301080458) | |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2020-11-16 |