| NPI | 1093255879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MT MED-PHYS-LIC-171192) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0102205358) |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2026-06-02 |