| 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 |