| NPI | 1700222635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101257142) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX R5285) |
| 207P00000X Emergency Medicine (Licence: MN 81418) | |
| Enumeration Date | 2013-05-19 |
| Last Update Date | 2026-01-05 |