| NPI | 1902219132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 52694) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ID 9861977) |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2024-12-02 |