| NPI | 1932187713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301088857) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 20404) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2023-08-16 |