| NPI | 1124601836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2025032307) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL OS21211) |
| Enumeration Date | 2021-04-30 |
| Last Update Date | 2026-02-19 |