| NPI | 1053342394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VT 0420007203) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV 12456) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2024-04-25 |