| NPI | 1922216027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME104100) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301086570) |
| Enumeration Date | 2007-05-20 |
| Last Update Date | 2025-03-20 |