| NPI | 1649381443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2010-00957) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 95823) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2025-11-04 |