| NPI | 1710563226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV DO3954) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 010933) |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2025-09-04 |