| NPI | 1649893918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 83164) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL 20021) |
| 207P00000X Emergency Medicine (Licence: NY 322746) | |
| 207P00000X Emergency Medicine (Licence: SC LL83164) | |
| Enumeration Date | 2020-05-21 |
| Last Update Date | 2023-10-10 |