| NPI | 1487714887 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301040365) | 
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: MI 4301040365) | 
| Enumeration Date | 2006-12-08 | 
| Last Update Date | 2025-09-11 |