| NPI | 1255747945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL me145418) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2017-01921) |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2025-04-22 |