| NPI | 1710959531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 9300012) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 93-00012) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2025-04-01 |