| NPI | 1013544915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 4132) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 83261) |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2023-07-19 |