| NPI | 1184885758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO 24899) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 102578) |
| 207P00000X Emergency Medicine (Licence: AZ 54111) | |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2025-04-01 |