| NPI | 1104484260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ID 2671976) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0102207012) |
| 207P00000X Emergency Medicine (Licence: SC LL82235) | |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2025-10-07 |