| NPI | 1225482169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101264390) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 83889) |
| 208D00000X General Practice (Licence: VA 0101264390) | |
| 207P00000X Emergency Medicine (Licence: OR MD224848) | |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2025-09-17 |