| NPI | 1689616302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 66176) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GU M-2172) |
| 207P00000X Emergency Medicine (Licence: WA MD00044765) | |
| 207P00000X Emergency Medicine (Licence: TN 65745) | |
| 207P00000X Emergency Medicine (Licence: KY C0654) | |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2022-05-20 |