| NPI | 1629274964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 103711) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC TL1106) |
| 207P00000X Emergency Medicine (Licence: NC 2007-00705) | |
| 207P00000X Emergency Medicine (Licence: SC 1106) | |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2025-09-29 |