| NPI | 1477231454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 81688) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 86899-20) |
| Enumeration Date | 2023-07-10 |
| Last Update Date | 2026-07-30 |