| NPI | 1992143028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 67219-21) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101020695) |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2019-06-05 |