| NPI | 1821616772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME161700) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 340977) |
| 207PP0204X Emergency Medicine Pediatric Emergency Medicine (Licence: LA 340977) | |
| Enumeration Date | 2020-07-08 |
| Last Update Date | 2025-02-18 |