| NPI | 1750878195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ND 24559) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2021021669) |
| Enumeration Date | 2018-04-20 |
| Last Update Date | 2026-09-14 |