| NPI | 1235875642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101028922) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX V9616) |
| Enumeration Date | 2022-05-09 |
| Last Update Date | 2026-05-04 |