| NPI | 1417319583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL 145181) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GU MC-306) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2026-01-28 |