| NPI | 1780316802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2025-03784) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME172270) |
| Enumeration Date | 2022-06-28 |
| Last Update Date | 2026-07-10 |