| NPI | 1952807323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 04935) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 008658) |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2023-05-04 |