| NPI | 1861843344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 70402) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2016022157) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2026-04-08 |