| NPI | 1215340146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 5960484-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NE 29353) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NE 29353) | |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2025-07-14 |