| NPI | 1861430332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: VA 0101236403) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD17739) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2026-06-23 |