| NPI | 1275996993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2024-03596) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0102204960) |
| 207P00000X Emergency Medicine (Licence: MD H0102646) | |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2026-06-09 |