| NPI | 1467136838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2026031476) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA R-12915) |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2026-07-24 |