| NPI | 1730823345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101288411) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301514272) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI 4301514272) | |
| Enumeration Date | 2022-04-21 |
| Last Update Date | 2026-07-09 |