| NPI | 1932317674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301088358) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 45020) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2017-04-21 |