| NPI | 1710299003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 47175) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 80112) |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2026-05-20 |