| NPI | 1790044550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: DC MD048800) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301100351) |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2022-03-11 |