| NPI | 1386105930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2022-01635) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 202201635) |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2025-05-20 |