| NPI | 1154550390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 67622) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 55810-21) |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2023-06-14 |