| NPI | 1790079119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 63493) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301098791) |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2024-01-31 |