| NPI | 1316082704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 200301276) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 23509) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2025-11-05 |