| NPI | 1558716746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA OP61171512) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 296647) |
| Enumeration Date | 2016-04-26 |
| Last Update Date | 2026-05-27 |