| NPI | 1790305316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 97579) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101277918) |
| Enumeration Date | 2020-04-23 |
| Last Update Date | 2026-08-17 |