| NPI | 1932542347 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME175284) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 61089) | 
| 207P00000X Emergency Medicine (Licence: AL MD.41202) | |
| Enumeration Date | 2013-04-16 | 
| Last Update Date | 2025-07-22 |