| NPI | 1730100736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: TX g0205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX G0205) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2023-01-17 |