| NPI | 1730167636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301041797) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI 4301041797) |
| 207P00000X Emergency Medicine (Licence: PA MD433111) | |
| 207P00000X Emergency Medicine (Licence: VA 0101243542) | |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2014-05-27 |