| NPI | 1306100706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC LL34864) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: UT 10411550-1205) |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2026-04-14 |