| NPI | 1699208637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME144836) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 81461) |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2025-06-18 |