| NPI | 1700574241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301516819) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301516819) |
| Enumeration Date | 2023-04-24 |
| Last Update Date | 2026-07-15 |