| NPI | 1609405281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA 185746) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 31805) |
| 207P00000X Emergency Medicine (Licence: FL ME157407) | |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2023-08-04 |