| NPI | 1184669137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AL 00012847) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 64891) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2025-07-17 |