| NPI | 1578091500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 81356) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 05-43010) |
| Enumeration Date | 2017-06-04 |
| Last Update Date | 2025-12-03 |