| NPI | 1871811414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 48302) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301099631) |
| Enumeration Date | 2010-05-06 |
| Last Update Date | 2015-11-16 |