| NPI | 1619357324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301108010) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 349331) |
| 207P00000X Emergency Medicine (Licence: IL 036.177385) | |
| 207P00000X Emergency Medicine (Licence: AZ 78643) | |
| 207P00000X Emergency Medicine (Licence: OH 35.136921) | |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2025-10-01 |