| NPI | 1548903693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ID 4671744) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR DO223850) |
| Enumeration Date | 2022-04-17 |
| Last Update Date | 2025-09-25 |