| NPI | 1922412279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WY 14756A) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101021230) |
| 207P00000X Emergency Medicine (Licence: WI 68949-21) | |
| Enumeration Date | 2014-06-15 |
| Last Update Date | 2024-02-14 |