| NPI | 1760917587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 87858) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5151013255) |
| 207P00000X Emergency Medicine (Licence: MI 5315082787) | |
| Enumeration Date | 2017-04-30 |
| Last Update Date | 2021-05-29 |