| NPI | 1770584310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KS 04-29138) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME159426) |
| Enumeration Date | 2005-08-04 |
| Last Update Date | 2025-10-13 |