| NPI | 1083235527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4351051302) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 62499) |
| Enumeration Date | 2020-05-06 |
| Last Update Date | 2026-09-23 |