| NPI | 1669964789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ R76952) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MT MED-PHYS-LIC-95633) |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2025-04-20 |