| NPI | 1720231103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101017882) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5315036836) |
| 207P00000X Emergency Medicine (Licence: NE 1130) | |
| Enumeration Date | 2008-10-29 |
| Last Update Date | 2014-01-28 |