| NPI | 1760453070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2005-00619) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NC 200500619) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2026-04-23 |