| NPI | 1659861441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2021-03167) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ R3014) |
| 207P00000X Emergency Medicine (Licence: WI 81145) | |
| 207P00000X Emergency Medicine (Licence: AZ 008602) | |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2023-07-18 |