| NPI | 1811964265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 90105) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 221572) |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2025-08-05 |