| NPI | 1639706591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 31944) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ID M-17103) |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2025-06-05 |