| NPI | 1366546301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME101413) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2004015870) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2025-11-13 |