| NPI | 1609514256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR DO229410) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT021722) |
| Enumeration Date | 2022-05-24 |
| Last Update Date | 2026-07-21 |