| NPI | 1316670193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME174977) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 74642) |
| Enumeration Date | 2022-07-08 |
| Last Update Date | 2025-06-20 |