| NPI | 1417582610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301514114) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4351049224) |
| Enumeration Date | 2020-03-08 |
| Last Update Date | 2025-06-09 |