| NPI | 1770923104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ R74144) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MT MED-PHYS-LIC-53220) |
| Enumeration Date | 2013-06-29 |
| Last Update Date | 2025-11-19 |