| NPI | 1558892356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 1015168) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD468114) |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2023-09-06 |