| NPI | 1982753489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SD 10180) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301079416) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI 4301079416) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2017-02-24 |