| NPI | 1245970607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5151015501) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5151015501APP22) |
| 207P00000X Emergency Medicine (Licence: NV DO3919) | |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2025-08-14 |