| NPI | 1457791378 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101020770)  | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 02006710A)  | 
| 207P00000X Emergency Medicine (Licence: CA 15608)  | |
| Enumeration Date | 2013-06-25 | 
| Last Update Date | 2024-05-29 |