| NPI | 1871098657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2022-01609) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2024-02-02 |