| NPI | 1104116193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME147511) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MS 23108) |
| 207P00000X Emergency Medicine (Licence: NC 199590) | |
| 207P00000X Emergency Medicine (Licence: AL MD.31861) | |
| 207P00000X Emergency Medicine (Licence: ID MC-1140) | |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2025-03-18 |