| NPI | 1013332881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM DO2022-0400) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0102204562) |
| 207P00000X Emergency Medicine (Licence: NM DO2022-0040) | |
| Enumeration Date | 2014-03-03 |
| Last Update Date | 2024-06-05 |