| NPI | 1770233025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME168769) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 105521) |
| Enumeration Date | 2022-03-28 |
| Last Update Date | 2025-08-11 |