| NPI | 1245972942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 06374) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 4281) |
| Enumeration Date | 2022-04-12 |
| Last Update Date | 2026-06-23 |