| NPI | 1720424807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 192581) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ID MC-1800) |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2023-01-12 |