| NPI | 1295745073 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 32920) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 85738) | 
| Enumeration Date | 2006-08-08 | 
| Last Update Date | 2025-09-19 |