| NPI | 1073042297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV DO3846) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 009108) |
| Enumeration Date | 2017-06-09 |
| Last Update Date | 2025-07-29 |