| NPI | 1114481892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME166747) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PR 36428) |
| Enumeration Date | 2019-01-26 |
| Last Update Date | 2024-08-02 |