| NPI | 1780180695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101024339) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WY 14831A) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2024-05-29 |