| NPI | 1164593281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MT 11553) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ME EC-05-018) |
| Enumeration Date | 2006-11-11 |
| Last Update Date | 2025-04-04 |