| NPI | 1134807142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AL 54625) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4351051113) |
| Enumeration Date | 2023-07-10 |
| Last Update Date | 2026-08-03 |