| NPI | 1376730903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IN 02004340A) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2010-00554) |
| 207P00000X Emergency Medicine (Licence: OH 34.009314) | |
| 207P00000X Emergency Medicine (Licence: FL OS20485) | |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2023-09-27 |