| NPI | 1831622430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 60116) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ R76017) |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2024-08-01 |