| NPI | 1518968155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2024008707) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 04-28117) |
| Enumeration Date | 2005-08-04 |
| Last Update Date | 2025-05-19 |