| NPI | 1811526486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VT 042.0018920) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101281422) |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2025-10-28 |