| NPI | 1649418294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS020502) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 02003739A) |
| 207P00000X Emergency Medicine (Licence: TX P3696) | |
| 207P00000X Emergency Medicine (Licence: GA 75423) | |
| Enumeration Date | 2009-02-04 |
| Last Update Date | 2022-04-19 |