| NPI | 1336589365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301102999) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ID MC-2002) |
| 207P00000X Emergency Medicine (Licence: FL ME170255) | |
| 207P00000X Emergency Medicine (Licence: TX U8196) | |
| Enumeration Date | 2013-07-05 |
| Last Update Date | 2026-05-27 |