| NPI | 1114583036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME164699) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 0450391) |
| Enumeration Date | 2019-05-16 |
| Last Update Date | 2026-07-16 |