| NPI | 1215498332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 59884) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AR E-14098) |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2024-12-02 |