| NPI | 1801857149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS012322) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GU DOC-052) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2026-02-23 |