| NPI | 1164884961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2019-00115) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101289719) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2026-08-24 |