| NPI | 1710548433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2022-01149) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NE 8608) |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2025-04-17 |