| NPI | 1023465630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ R75733) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: HI MD-20274) |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2025-05-21 |