| NPI | 1962440396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 3065) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101016593) |
| 207P00000X Emergency Medicine (Licence: SC 1156) | |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2017-03-22 |