| NPI | 1306037486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA MD201632) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 62629) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2025-11-01 |