| NPI | 1619977261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 33157) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 204682) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2025-10-01 |