| NPI | 1922748821 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 94611) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC LL87694) | 
| Enumeration Date | 2022-03-30 | 
| Last Update Date | 2025-08-05 |