| NPI | 1619543105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME171478) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301511849) |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2025-07-10 |