| NPI | 1770335465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IA DO-55498) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA R-13177) |
| Enumeration Date | 2024-04-04 |
| Last Update Date | 2025-12-19 |