| NPI | 1790348605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MD D93152) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: DE C1-0024042) |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2026-07-10 |