| NPI | 1457764763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301105698) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301105698) |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2025-01-22 |