| NPI | 1962541169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS014033) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101015839) |
| 207P00000X Emergency Medicine (Licence: CA 20A15211) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2021-10-07 |