| NPI | 1679077267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 89395) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 52039) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2021-09-15 |