| NPI | 1578784773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MS 21632) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL 29251) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2025-03-26 |