| NPI | 1457885964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2022-01227) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 82759) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2026-05-30 |