| NPI | 1245677244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 39145) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2015-02117) |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2026-07-26 |