| NPI | 1902888084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL OS19273) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CO 42078) |
| 207P00000X Emergency Medicine (Licence: GA 70711) | |
| 207P00000X Emergency Medicine (Licence: CA 20A9319) | |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2024-02-14 |