| NPI | 1821414913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD214339) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM MD2025-0556) |
| Enumeration Date | 2014-03-13 |
| Last Update Date | 2025-09-16 |