| NPI | 1821431644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2025037408) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2016-00834) |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2026-04-21 |