| NPI | 1528179090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD23778) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: OR MD23778) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2023-02-16 |