| NPI | 1790741601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA VA0101234112) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2012-01225) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2023-01-24 |