| NPI | 1730717414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME162140) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD D0103044) |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2025-04-16 |