| NPI | 1770711566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD61366866) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301095019) |
| 207P00000X Emergency Medicine (Licence: KY 52512) | |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2024-04-23 |