| NPI | 1558091801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NE 9312) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NE 36829) |
| Enumeration Date | 2022-06-10 |
| Last Update Date | 2025-07-22 |