| NPI | 1669176160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 06250) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL 4451) |
| Enumeration Date | 2023-03-28 |
| Last Update Date | 2026-05-11 |