| NPI | 1821597600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 75225-21) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL 21877) |
| 207P00000X Emergency Medicine (Licence: AZ 011417) | |
| 207P00000X Emergency Medicine (Licence: TX V2867) | |
| Enumeration Date | 2018-02-07 |
| Last Update Date | 2025-03-03 |