| NPI | 1063485415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL OS9546) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 02009181A) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2026-09-03 |