| NPI | 1578192670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 89704) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 72341) |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2026-07-21 |