| NPI | 1639342819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV DO3915) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2012014551) |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2025-09-04 |