| NPI | 1679150981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 85441-20) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 110795) |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2026-07-04 |