| NPI | 1306057732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102202607) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 02007508A) |
| 207P00000X Emergency Medicine (Licence: MI 5101016000) | |
| 207P00000X Emergency Medicine (Licence: TX P2388) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2024-07-02 |