| NPI | 1629656376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD229179) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2024-01462) |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2026-06-17 |