| NPI | 1306611025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 11336) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 11336) |
| Enumeration Date | 2023-11-22 |
| Last Update Date | 2025-09-21 |