| NPI | 1720222805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NE 27145) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA MD-51783) |
| 207P00000X Emergency Medicine (Licence: MN 55945) | |
| Enumeration Date | 2009-04-21 |
| Last Update Date | 2026-07-23 |