| 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 |