| NPI | 1720078793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI 4301091378) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35083879B) |
| 207L00000X Anesthesiology (Licence: MI 4301091378) | |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2012-04-27 |