| NPI | 1639668916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL 144588) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MT MED-PHYS-LIC-143282) |
| 207P00000X Emergency Medicine (Licence: AL 42917) | |
| Enumeration Date | 2018-05-02 |
| Last Update Date | 2025-04-20 |