| NPI | 1619439460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 58760) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101274701) |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2025-04-08 |