| NPI | 1629298757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 48138) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101256622) |
| Enumeration Date | 2007-04-30 |
| Last Update Date | 2025-01-31 |