| NPI | 1023013869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 200401250) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101274846) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2025-02-16 |