| NPI | 1093917072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2010-00154) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA 0T011760) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2023-01-26 |