| NPI | 1659515617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IA 46135) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME110142) |
| Enumeration Date | 2009-04-21 |
| Last Update Date | 2024-09-24 |