| NPI | 1053495846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 48861-021) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2012039492) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2024-04-10 |