| NPI | 1245764182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL OS16991) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT017670) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2024-03-27 |