| NPI | 1225237944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 4849) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ME EC071078) |
| 207P00000X Emergency Medicine (Licence: NC 2010-00947) | |
| 207P00000X Emergency Medicine (Licence: GU MC-303) | |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2025-07-10 |