| NPI | 1790273365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301506632) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 101275052) |
| Enumeration Date | 2018-04-28 |
| Last Update Date | 2022-06-14 |