| NPI | 1699111245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ O-008785) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ID O-1413) |
| 207P00000X Emergency Medicine (Licence: WY 13258A) | |
| 207P00000X Emergency Medicine (Licence: OK O-8281) | |
| 207P00000X Emergency Medicine (Licence: MO 2023034953) | |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2026-04-01 |