| NPI | 1851063440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 61778) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: UT 14130963-1205) |
| 207P00000X Emergency Medicine (Licence: AL MD.53459) | |
| 207P00000X Emergency Medicine (Licence: GA 111038) | |
| Enumeration Date | 2021-10-01 |
| Last Update Date | 2026-09-22 |