| NPI | 1790352466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 51505148) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ME DO3829) |
| 207P00000X Emergency Medicine (Licence: NY 327866) | |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2024-07-01 |