| NPI | 1245855154 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC LL84407) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 76114) | 
| Enumeration Date | 2020-06-16 | 
| Last Update Date | 2025-07-02 |