| NPI | 1861194649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2026-02804) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101285629) |
| Enumeration Date | 2023-03-17 |
| Last Update Date | 2026-08-18 |