| NPI | 1316965783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA 023541) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 73957) |
| 207P00000X Emergency Medicine (Licence: NV 27282) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2025-05-09 |