| NPI | 1073888236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 57391) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 261686) |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2026-02-04 |