| NPI | 1861142333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VT 042.0040106) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301513502) |
| Enumeration Date | 2022-03-27 |
| Last Update Date | 2026-07-21 |