| NPI | 1891185229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101260860) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GU M-2392) |
| Enumeration Date | 2015-01-22 |
| Last Update Date | 2025-03-06 |