| NPI | 1760746168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 73805) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC LL34649) |
| 207P00000X Emergency Medicine (Licence: TX V3523) | |
| 207P00000X Emergency Medicine (Licence: ME MD28649) | |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2026-01-14 |