| NPI | 1740258516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME0040874) |
| Additional Taxonomies | 208VP0000X (Licence: FL ME40874) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2025-08-05 |