| NPI | 1952830481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MT 123319) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101023029) |
| 207P00000X Emergency Medicine (Licence: WY TL6681) | |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2024-04-05 |