| NPI | 1962628552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101243058) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301085957) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2022-08-05 |