| NPI | 1851719587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 85557) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2018-00540) |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2025-07-23 |