| NPI | 1083683957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA MD202822) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD44196) |
| 207P00000X Emergency Medicine (Licence: HI 13553) | |
| 207P00000X Emergency Medicine (Licence: KS 04-46350) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2025-04-10 |