| NPI | 1073172052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2025-01378) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD D94755) |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2025-12-01 |