| NPI | 1649665233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 273956) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 322459) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2023-11-15 |