| NPI | 1194219972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 009894) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 05525) |
| 207P00000X Emergency Medicine (Licence: MI 5101025078) | |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2026-06-24 |