| NPI | 1154339323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 49505) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CO CDRH.0046097) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2026-01-22 |