| NPI | 1720517295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME143217) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PR 32847-R) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2023-03-07 |