| NPI | 1326454950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV ED0445A) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD H0102221) |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2025-08-06 |