| NPI | 1073559985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101058840) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM MD2020-0012) |
| 207P00000X Emergency Medicine (Licence: IN 01046265A) | |
| 207P00000X Emergency Medicine (Licence: WI 102308) | |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2024-10-31 |