| NPI | 1225602329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 77352) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301510146) |
| Enumeration Date | 2021-05-14 |
| Last Update Date | 2025-09-21 |