| NPI | 1194175042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 75558) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101266353) |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2025-05-05 |