| NPI | 1780887158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301101765) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME98530) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2013-07-23 |