| NPI | 1376119974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV 25950) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4351048227) |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2024-07-30 |