| NPI | 1417687427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2025-00190) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4351049814) |
| Enumeration Date | 2022-06-13 |
| Last Update Date | 2025-06-30 |