| NPI | 1891179388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD61332227) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 29670-1) |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2024-04-17 |