| NPI | 1619364023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: DC MD046330) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 1010264594) |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2025-04-02 |