| NPI | 1740676634 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM MD2017-0826)  | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM RS2015-0385)  | 
| 207P00000X Emergency Medicine (Licence: NM 1740676634)  | |
| Enumeration Date | 2015-04-08 | 
| Last Update Date | 2025-01-15 |