| NPI | 1720045263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX J1987) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AK MEDS4907) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2025-08-24 |