| NPI | 1184183568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR DO228997) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 80373) |
| Enumeration Date | 2019-03-15 |
| Last Update Date | 2026-07-21 |