| NPI | 1790981025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ID M-10675) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD183879) |
| Enumeration Date | 2007-06-24 |
| Last Update Date | 2023-04-04 |