| NPI | 1407423809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MS 32525) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 337599) |
| Enumeration Date | 2021-06-05 |
| Last Update Date | 2025-07-29 |