| NPI | 1881222925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KS 04-48037) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2023025168) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2024-04-11 |