| NPI | 1982380341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care (Licence: LA 229774) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: LA 229774) |
| Enumeration Date | 2023-06-22 |
| Last Update Date | 2025-01-31 |