| NPI | 1720363831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL 119327) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 60608) |
| Enumeration Date | 2011-10-20 |
| Last Update Date | 2025-03-25 |