| NPI | 1568103968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV 27874) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: UT 14217668-1205) |
| Enumeration Date | 2022-04-07 |
| Last Update Date | 2025-09-04 |