| NPI | 1639597610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 078018) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ME MD24028) |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2025-10-06 |