| NPI | 1679060743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 83719) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MS 27679) |
| Enumeration Date | 2018-04-15 |
| Last Update Date | 2026-01-05 |