| NPI | 1295098416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WY 10229A) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301101289) |
| 207P00000X Emergency Medicine (Licence: MT MED-PHYS-LIC-92059) | |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2026-06-22 |