| NPI | 1225491319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 202301547) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101267414) |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2023-06-21 |