| NPI | 1043625080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2018-00507) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 6906) |
| Enumeration Date | 2014-06-28 |
| Last Update Date | 2026-05-21 |