| NPI | 1811945470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 30343) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NC 30343) |
| 207P00000X Emergency Medicine (Licence: NC 30343) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2023-10-24 |