| NPI | 1104455385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101278509) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2022-03206) |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2025-10-22 |