| NPI | 1740631852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2020020221) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101022703) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2026-05-22 |