| NPI | 1164126124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 82862) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 87839-20) |
| 207P00000X Emergency Medicine (Licence: IL 125.082076) | |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2026-08-08 |