| NPI | 1174814073 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AK 8316)  | 
| Additional Taxonomies | 207PH0002X Emergency Medicine, Hospice and Palliative Medicine (Licence: MO 2021050909)  | 
| Enumeration Date | 2011-04-26 | 
| Last Update Date | 2023-09-20 |