| NPI | 1205046653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WY 8360A) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 005285) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2022-07-21 |