| NPI | 1689863821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MD H0070416) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0102204461) |
| 207P00000X Emergency Medicine (Licence: MA 258889) | |
| 207P00000X Emergency Medicine (Licence: PA OS014667) | |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2024-08-23 |