| NPI | 1831659093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM MD2025-0366) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2024003943) |
| Enumeration Date | 2019-03-23 |
| Last Update Date | 2025-06-16 |