| NPI | 1700057585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME116080) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2025-00876) |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2025-08-25 |