| NPI | 1124014832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD217521) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 016698) |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2025-08-12 |