| NPI | 1740507797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101254805) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 30537) |
| Enumeration Date | 2010-04-30 |
| Last Update Date | 2025-03-10 |