| NPI | 1043963382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV DO4198) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: UT 14263285-1204) |
| Enumeration Date | 2022-01-27 |
| Last Update Date | 2026-09-03 |