| NPI | 1619541281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL 21230) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2023010431) |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2024-07-12 |