| NPI | 1639673544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD61224889) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD D92039) |
| 207P00000X Emergency Medicine (Licence: NV 29558) | |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2026-05-26 |