| NPI | 1366079634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX W8398) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME162528) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2026-08-27 |