| NPI | 1619473204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 1026680) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV 21143) |
| 207P00000X Emergency Medicine (Licence: NV 2114) | |
| 207P00000X Emergency Medicine (Licence: NE 32129) | |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2026-06-17 |