| NPI | 1255821781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV 27891) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 61532) |
| 207P00000X Emergency Medicine (Licence: VA 0101272021) | |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2025-09-30 |