| NPI | 1063669158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV 27406) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 40474) |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2025-08-12 |