| NPI | 1063160695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MD D0106561) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: DC MD60005590) |
| 207P00000X Emergency Medicine (Licence: VA 0101288809) | |
| Enumeration Date | 2022-03-14 |
| Last Update Date | 2026-04-25 |