| NPI | 1346827854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 1016721) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 79027) |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2026-04-03 |