| NPI | 1760802813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2022-03058) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 269233) |
| 207P00000X Emergency Medicine (Licence: HI MD-20598) | |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2023-03-24 |