| NPI | 1831395888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 53366) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101016338) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2026-03-04 |