| NPI | 1245793504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 66235) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ R77315) |
| Enumeration Date | 2019-04-12 |
| Last Update Date | 2022-05-12 |